Provider First Line Business Practice Location Address:
2825 CAPITOL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95616-5616
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-447-6267
Provider Business Practice Location Address Fax Number:
916-456-5842
Provider Enumeration Date:
10/26/2006